Interview Prof. Andreas Stavropoulos
* First published: Dental Asia November/December 2019 (short version)
The 17th Biennial conference of the IAP in Bangkok presented a variety of talks and workshops in the field of periodontology. In addition to discussing new developments and current approaches to the management of periodontal diseases, further insights on the associations of systemic- and periodontal diseases as well as therapeutic approaches were shown. A practice day offered hands on workshops with the opportunity to learn from acclaimed experts in their respective fields and discuss patient cases.
Prof. Stavropoulos, your workshop Management of peri-implantitis: a pragmatic approach unites theoretical knowledge and practical application. Among other things, you also teach various techniques applying different instruments and devices.
What motivates you to continuously conduct these immersive workshops, especially in different parts of the world?
AS: Peri-implantitis is rather common among patients with implants and the dental community started accepting to diagnose it only relatively recently. Previously, implants were for life and one should not touch them, meaning not probing the pockets around an implant. Probably, there is not a big variation in prevalence of the disease in various parts of the world, but we in Europe may be more sensitized to the problem and look more readily for possible signs of peri-implantitis, compared with other parts of the world. In addition, management of peri-implantitis is not straightforward and there is no standard treatment, as it is with the treatment of periodontitis. However, if one considers some important aspects of the condition, and one has a pragmatic approach and expectations, then the clinical outcomes are actually quite good in the majority of the cases. I think it is our duty to educate our colleagues on the topic, when there is such opportunity, irrespective the part of the world.
Could you give us a brief description of your workshop?
AS: The workshop always starts with a lecture on the basics regarding diagnosis, etiology and pathogenesis of peri-implant biological complications, and on the important parameters that influence progression and/or treatment outcome. I include a lot of videos of clinical procedures and several patient cases, so that the participants can see how things are done in the clinic and the outcome of treatment. Then there are the hands-on exercises, using specially developed plastic models with soft tissue imitation and different type of peri-implant bone defects. This allows practicing different types of surgical techniques – from resective to regenerative.
Depending on the timeframe (half- or one day workshop), the lecture takes 1 to 2 hours and the practical part 2 to 4 hours. There are always good industry partners supporting the workshops with the most up-to-date instruments/devices and a variety of regenerative products. Without the partners, the workshops would not be possible to do.
Is there a specific message or skill-set you hope participants will take home after the workshop?
AS: A very important message is that in the majority of peri-implantitis cases one should not waste time by observing, “how it will go” with non-surgical treatment, but choose a surgical approach. I also expect participants to understand which surgical approach, resective or regenerative, should be delivered in each specific indication.
Based on your experience, is the diagnosis peri-implantitis always equivalent to “no” implant in the long run?
AS: Although there are not many studies with long-term data from peri-implantitis treatment, I cannot see why successfully treated peri-implantitis cases cannot be maintained for several years, provided the patients perform efficient oral hygiene and follow an individually tailored supportive therapy scheme. It may often be that implants are more challenging to be properly cleaned by the patient comparing to teeth, due to the prosthetic reconstruction, and this is of course an issue.
As you already mentioned, there is no standard treatment for peri-implantitis. In your opinion, should treatments be planned and adapted to each individual patient case? How does one decide whether to take a surgical or non-surgical (conservative) approach?
AS: One has to consider some important parameters that influence the progression and/or the outcome of treatment, that are often specific for each individual implant of each patient, and act accordingly. However, what is in a way common in most of the cases is that a surgical approach is needed for successful treatment of peri-implantitis.
Which devices/instruments do you personally prefer to work with in regards to the treatment of peri-implantitis? Are there any specific reason for this choice (and would you tell us)? How important are hands-on trainings with these devices/instruments, is reading the manual or a demonstration not enough?
AS: For peri-implantitis treatment, I am very fond of air polishing devices, especially those that accommodate a flexible tip for subgingival use. They are quite efficient for biofilm removal and very user- and patient-friendly; for example, non-surgical treatment with the use of air polishing is performed most of the times without anesthesia. I also like to use piezo surgery devices, in cases where autogenous bone chips (flakes) need to be harvested during a regenerative approach, and also in cases where an implant with peri-implantitis is deemed to extraction, but is still so strongly osseointegrated that it cannot be removed with an explantation kit; this can happen some times in the mandible. In this context, hands-on training with such devices gives indeed a good feeling about how it is to work with them in the clinic; it is definitely not the same to have the device at hand, see and feel it in function, with just reading the instruction manual. During a hands-on training, the participants can ask the instructors about personal experiences and tips/tricks, which are not easy to describe in a brochure. Also, during the workshops, representatives of the industry are usually present, who can answer all possible technical queries that a colleague may have.